Both kids had direct contact with swine prior to infection and there is no evidence of human to human transmission. BUT what caught my eye is this:

"The particular strain the children contracted hasn't been seen before, said Tom Skinner, CDC spokesman. While the CDC typically sees a few cases a year of H3N2 (an influenza A virus), usually as result of contact with swine, "what's new is that it has picked up a gene from the H1N1 pandemic strain," said Skinner."

Indiana and Pennsylvania aren't exactly neighbors. As my DD is now involved in raising pigs (and we are in PA), this is something I'd like hear more about.

ETA, there was something in the chat area over the last couple of days about a nasty H3N2 on the way. Wonder if this related.

Off to PFI...

__________________"Now, mark my words. So long as we are a young and virtuous people, this instrument will bind us together in mutual interests, mutual welfare, and mutual happiness. But when we become old and corrupt, it will bind us no longer" - Alexander Hamilton about the US Constitution.

Here are the case reports from the CDC. Contrary to the info in the original article, it looks like one kid had direct contact and one had INdirect contact with swine prior to infection. And, the report suggests the possibility of h2h spread although there's no evidence of ongoing transmission.

"...The lack of known direct exposure to pigs in one of the two cases described in this report suggests the possibility that limited human-to-human transmission of this influenza virus occurred...Preliminary evidence from the investigation of the Indiana case shows no ongoing transmission."

Tomorrow’s MMWR (week 34) will report two more pandemic H3N2 cases (trH3N2). The cases in Indiana increase that state’s total to two, with both cases reported in a one month period. The H3 sequence, A/Indiana/08/2011, from the first case (1M) was closely related to the sequence from the Minnesota cluster, as well as cases in Wisconsin and Pennsylvania in 2010. The presence of similar sequence in human cases collected over a one year period raised concerns of human adaptation.

The latest cases raise the total for Pennsylvania to three and raise concerns that all three recent cases will have similar H3 sequences. The H3 sequence from Minnesota has been selected as a pandemic H3N2 vaccine target.

Release of sequences from the two recent cases, as well as information on the three recent cases would be useful. The CDC has not updated its website since January of this year, in spite of a confirmed cluster in MN, two confirmed cases in PA, and two confirmed cases in IN after the last update.

The reporting of three trH3N2 cases in the past month is without precedence.

The above data is from today’s MMWR (week34), which cites two new trH3N2 infections in Pennsylvania and Indiana. The listing of two trH3N2 for the current week is without precedent. Prior cases (A/Kansas/13/2009, A/Iowa/16/2009, A/Minnesota/09/2010, A/Pennsylvania/40/2010, A/Wisconsin/12/2010, A/Pennsylvania/14/2010, A/Minnesota/11/2010, and A/Indiana/08/2011), were reported after the fact, and in many cases the reporting was months after the fact.

Two of the cases (WI/12/10 and PA/14/10) were announced in a WHO pager alert, which generated alarm in Europe. However, the WHO noted that the cases were isolated 6 weeks apart and the sequences were distinct and not from a common source and therefore the trH3N2 was not transmitting. However, PA/40/10 was from a patient infected within a week of WI/12/10 and the sequences were virtually identical, but PA/40/10 was not reported until 2011 and the close identity was not noted by the CDC. Thus, when the alert was announced there really were three cases (two in September and one in October) and the two September cases raised transmission concerns.

These concerns were increased when MN/11/10 was announced. The sequences from the November case was closely related to WI/12 and PA/40, and contacts of MN/11 were under investigation. In 2011 the daughter of the MN index case was H3N2 confirmed, and her lack of swine contact indicated she was infected by her father. Moreover, additional family members had been symptomatic, indicating MN/11 had spread. Concern regarding this spread increased when the CDC deposited sequencing indicating MN/11 had been selected as a vaccine target.

Concern was increased further when a new case was announced in the week 30 MMWR. That announcement was followed by the release of a set of sequences from Indiana, which was a reassortant that had acquired a pandemic H1N1 MP gene segment. Moreover, this isolate had an H3 that was closely related to the sequences from MN, PA, and WI raising concerns that this H3 was adapting to humans.
In spite of increased swine surveillance, which included release of HA sequences, most of the H3 sequences closely related to IN/08/11 were human trH3N2 isolates, and today’s MMWR cites another Indiana case as well as another Pennsylvania case.

Although the spike in cases in the past month is of more concern that the two cases cited in the 2010 pager alert, WHO and the CDC have not commented on these cases, or the selection of MN/11 as a pandemic vaccine target.

The relationship between the Indiana cases is unknown, which is also true for the recent Pennsylvania case.

More information on these cases is overdue.

BREAKING: Media reports indicate the two recent cases are children infected with trH3N2 with H1N1 MP.

There are a lot more commentaries. The cases are still sporadic and it's back to the old game of finding long chains of infection but then again we watched H5N1 for years. The big clusters were a lot of cases (8 or so) but all a point source or one step of transfer in close contact.

Then pH1N1 jumped us. Off course both pH1N1 and trH3N2 are swine flu and both closer to human flu then bird flu so it should be easier for them to take of/adapt to humans. It's one to watch.

so it's segment 7 (MP) which originally came from European Swine(1978)
and already reassorted a lot in swine

2009mexflu had got segments 6,7 from that 1978EurasiaSwineH1N1

we had an outbreak of H1N2 in humans in 2001-2003 which (almost)
disappeared when Fujianflu took over in 2002-2004

that H1N2 had 7 segments from seasonal H3N2(1968flu) but picked up segment 4
from seasonal H1N1(1977flu)

some years ago a new H3N1 appeared in Missouri swine, but only one infection
is known.
Then we also had H2N3,H1N3, but that didn't spread either.
However now we have losts of reassortants in swine in different segments
mixing old swinish H3N2,H1N2,H1N1 with pandemic H1N1 (mexflu,2009flu).

We have some immunity to that new H3N2 from our seasonal H3N2.
But that strain is ~20years old and thus pretty different from current human
H3N2 (40 years away, for those who had H3N2 in ~1990 only 20years away)

more dangeroud to me looks Eurasian swinish H1N1, which might
give it's H1 to other flu and we have no immunity to that one.
There were some occasional human infections in Europe with that
swinish H1N1 and they were usually mild.
But when it starts to reassort (as it does now in swine) the
cards are new mixed

Both kids had direct contact with swine prior to infection and there is no evidence of human to human transmission. BUT what caught my eye is this:

"The particular strain the children contracted hasn't been seen before, said Tom Skinner, CDC spokesman. While the CDC typically sees a few cases a year of H3N2 (an influenza A virus), usually as result of contact with swine, "what's new is that it has picked up a gene from the H1N1 pandemic strain," said Skinner."

With flu viruses so common in humans, as well as swine & birds - animals with which we have frequent contact as we are heavy consumers of them; as well as flu being so mutable, I'm willing to bet the few cases reported by CDC are the smallest tip of a rather large iceburg. I'll bet as well that were the same investigations done in swine & domestic fowl, we'd see the same results - human flu strains sharing gene segments with predominantly 'animal' strains.

TWO cases here & remember, both patients recovered. Furthermore, one had pre-existing health issues. Certainly this bears close watching - for all our watching & analysis, nobody can say with any degree of certainty where the next pandemic strain might come from, when or how bad it might be. Frankly, the next pandemic could come out of an H4N6 for all anyone knows. We don't have the resources to track them all genetically so clinical observation & testing of any hinky case is our only real hope of finding variants flying under the radar.

And as we saw with SARS, a perviously 'harmless' garden variety virus can turn ugly exceptionally quickly. I used to bite my nails over EVERY weird new illness report but frankly there are too may, the overwhelming major go nowhere & life is too short; it's not the most enjoyale obessession!

Swine-origin influenza A (H3N2) virus infection in 2 children
-------------------------------------------------------------
Influenza A viruses are endemic in many animal species, including humans, swine, and wild birds, and sporadic cases of transmission of influenza A viruses between humans and animals do occur, including human infections with avian-origin influenza A viruses (that is, H5N1 and H7N7) and swine-origin influenza A viruses (that is, H1N1, H1N2, and H3N2) (1). Genetic analysis can distinguish animal origin influenza viruses from the seasonal human influenza viruses that circulate widely and cause annual epidemics. This report describes 2 cases of febrile respiratory illness caused by swine-origin influenza A (H3N2) viruses identified on 19 Aug 2011 and 26 Aug 2011, and the current investigations. No epidemiologic link between the 2 cases has
been identified, and although investigations are ongoing, no additional confirmed human infections with this virus have been detected. These viruses are similar to 8 other swine-origin influenza A (H3N2) viruses identified from previous human infections over the past 2 years, but are unique in that one of the 8 gene segments (matrix [M] gene) is from the 2009 influenza A (H1N1) virus. The acquisition of the M gene in these 2 swine-origin influenza A (H3N2) viruses indicates that they are "reassortants" because they contain
genes of the swine-origin influenza A (H3N2) virus circulating in North American pigs since 1998 (2) and the 2009 influenza A (H1N1) virus that might have been transmitted to pigs from humans during the 2009 H1N1 pandemic. However, reassortments of the 2009 influenza A (H1N1) virus with other swine influenza A viruses have been reported previously in swine (3). Clinicians who suspect influenza virus infection in humans with recent exposure to swine should obtain a nasopharyngeal swab from the patient for timely diagnosis at a state public health laboratory and consider empiric neuraminidase inhibitor antiviral treatment to quickly limit potential human transmission (4).

Case reports
------------
Patient A -- On 17 Aug 2011, the United States Centers for Disease
Control and Prevention [CDC] was notified by the Indiana State Department of Health Laboratories of a suspected case of swine-origin influenza A (H3N2) infection in a boy aged <5 years. The boy, who had received influenza vaccine in September 2010, experienced onset of fever, cough, shortness of breath, diarrhea, and sore throat on 23 Jul 2011. He was brought to a local emergency department (ED) where a respiratory specimen later tested positive for influenza A (H3). The boy was discharged home, but was not treated with influenza antiviral medications. He has multiple chronic health conditions, returned to the ED on 24 Jul 2011, and was hospitalized for treatment of those health problems, which had worsened. The boy was discharged home on 27 Jul 2011, and has since recovered from this illness. As part of routine CDC-supported influenza surveillance, the respiratory specimen
collected on 24 Jul 2011, was forwarded to the Indiana State Department of Health Laboratories, where polymerase chain reaction (PCR) testing identified a suspect swine-origin influenza A (H3N2) virus on 17 Aug 2011. The specimen was forwarded to CDC where the findings were confirmed through genome sequencing on 19 Aug 2011.

No direct exposure to swine was identified for this child; however, a caretaker reported direct contact with asymptomatic swine in the weeks
before the boy's illness onset and provided care to the child 2 days before illness onset. No respiratory illness was identified in any of the child's family or close contacts, the boy's caretaker, or in the family or contacts of the caretaker.

Patient B -- On 24 Aug 2011, CDC was notified by the Pennsylvania
Department of Health of a suspected case of swine-origin influenza A (H3N2) virus infection in a girl aged <5 years. The girl, who had received influenza vaccine in September 2010, experienced acute onset of fever, nonproductive cough, and lethargy on 20 Aug 2011. She was brought to a local hospital ED where a nasopharyngeal swab tested positive for influenza A by rapid influenza diagnostic test. She was not treated with influenza antiviral medications and was discharged home the same day. The girl has completely recovered from this illness.

A nasopharyngeal swab and nasal wash specimen were obtained at the ED and forwarded to the Pennsylvania State Department of Health Bureau of Laboratories for additional testing as part of routine CDC-supported influenza surveillance. On 29 Aug 2011, the state public health laboratory identified a suspected swine-origin influenza A (H3N2) virus by PCR testing, and both specimens were forwarded to CDC. On 26 Aug 2011, genome sequencing confirmed the virus as swine-origin influenza A (H3N2). On 16 Aug 2011, the girl was reported to have visited an agricultural fair where she had direct exposure to swine and other animals. No additional illness in the girl's family or close contacts has been identified, but illness in other fair attendees
continues to be investigated. No additional confirmed swine-origin influenza virus infections have been identified thus far.

Epidemiologic and laboratory investigations
-------------------------------------------
As of 2 Sep 2011, no epidemiologic link between patients A and B had been identified, and no additional cases of confirmed infection with the identified strain of swine-origin influenza A (H3N2) virus had been identified. Surveillance data from both states showed low levels of influenza activity at the time of both patients' illnesses. Case and contact investigations by the county and state human and animal health agencies in Indiana and Pennsylvania are ongoing, and enhanced surveillance for additional human cases is being implemented in both states.

Preliminary genetic characterization of these 2 influenza viruses has
identified them as swine-origin influenza A (H3N2) viruses. Full genome sequences have been posted to publicly available Web sites. The viruses are similar, but not identical to each other. 7 of the 8 gene segments, including the hemagglutinin (HA) and neuraminidase (NA) genes, are similar to those of swine H3N2 influenza viruses circulating among U.S. pigs since 1998 (2) and previously identified in the 8 other sporadic cases of human infection with swine-origin influenza A (H3N2) viruses in the United States since 2009 [Additional information is available at <http://www.cdc.gov/flu/weekly/pastreports.htm>]. The one notable
difference from the viruses previously identified in human infections with swine-origin influenza A (H3N2) virus is that these 2 viruses have a matrix (M) gene acquired from the 2009 influenza A (H1N1) virus, replacing the classical swine M gene present in the prior 8 swine-origin influenza A (H3N2) virus infections in humans.

Although reassortment between swine influenza and 2009 influenza A (H1N1) viruses has been reported in pigs in the United States (3), this particular genetic combination of swine influenza virus segments is unique and has not been reported previously in either swine or humans, based on a review of influenza genomic sequences publicly available in GenBank. Analysis of data submitted to GenBank via the US Department of Agriculture (USDA) Swine Influenza Virus Surveillance Program subsequent to this case identified 2 additional influenza A (H3N2) isolates from swine containing the M gene from the 2009 influenza A (H1N1) virus. Genome sequencing is under way to completely characterize the genetic composition of these 2 swine influenza
isolates. (USDA Agricultural Research Service and USDA Animal and Plant Health Inspection Service, unpublished data, 2011).

The viruses in these 2 patients are resistant to amantadine and rimantadine, but are susceptible to the neuraminidase inhibitor drugs oseltamivir and zanamivir. Because these viruses carry a unique combination of genes, no information currently is available regarding the capacity of this virus to transmit efficiently in swine, humans, or between swine and humans.

MMWR editorial note
-------------------
From 2005 to 2007, CDC received reports of about one human infection with a swine-origin influenza virus each year. In 2007, human infection with a novel influenza A virus, including swine-origin influenza virus infections, became a nationally notifiable condition. Since that time, CDC has received about 3 to 5 reports a year of human infections with swine-origin influenza viruses. The recent increase in reporting might be, in part, a result of increased influenza testing capabilities in public health laboratories that allows for identification of human and swine-origin influenza viruses, but
genetic changes in swine influenza viruses and other factors also might be contributing to this increase (5--7). During December 2005--November 2010, before the 2 cases described in this report, 21 cases of human infection with swine-origin influenza were reported (12 cases with swine-origin influenza A (H1N1) virus infection, 8 cases with swine-origin influenza A (H3N2) virus infection, and one case with swine-origin influenza A (H1N2) virus infection). 6 of these 21 cases occurred in patients who reported direct exposure to pigs; 12 patients reported being near pigs; human-to-human transmission was
suspected in 2 cases after epidemiologic investigations revealed no reported contact with swine in either case, but contact with ill persons who reported swine exposure was the suspected source of infection; the exposure in one case was unknown (8) (CDC, unpublished data; 2011). Although the vast majority of human infections with animal influenza viruses do not result in human-to-human transmission (9,10), each case should be investigated fully to ascertain whether these viruses are transmitted among humans and to limit further exposure of humans to infected animals, if infected animals are
identified.

The lack of known direct exposure to pigs in one of the 2 cases described in this report suggests the possibility that limited human-to-human transmission of this influenza virus occurred. Likely transmission of swine-origin influenza A (H3N2) virus from close contact with an infected person has been observed in past investigations of human infections with swine-origin influenza A virus, but has not resulted in sustained human-to-human transmission. Preliminary evidence from the investigation of the Indiana case shows no ongoing transmission. No influenza illness has been identified, but if additional chains of transmission are identified rapid intervention is warranted try to prevent further spread of the virus. Clinicians should consider swine-origin influenza A virus infection as well as seasonal influenza virus infections in the differential diagnosis of patients with febrile respiratory illness who have been near pigs.
Clinicians who suspect influenza virus infection in humans with recent
exposure to swine, should obtain a nasopharyngeal swab from the patient, place the swab in a viral transport medium, contact their state or local health department to facilitate transport and timely diagnosis at a state public health laboratory, and consider empiric neuraminidase inhibitor antiviral treatment (4).

[Interested readers should access the original document at the source URL to view the references cited in the above text]

[This report describes 2 cases of febrile respiratory illness caused by swine-origin influenza A (H3N2) viruses identified on 19 Aug 2011 and 26 Aug 2011. The viruses identified in these cases are unique in that one of the 8 gene segments (matrix [M] gene) is derived from the 2009 influenza A (H1N1) virus.

Non-human influenza virus infections rarely result in human-to-human
transmission, but the implications of sustained ongoing transmission between humans is potentially severe; therefore, prompt and thorough identification and investigation of these sporadic human infections with non-human influenza viruses are needed to reduce the risk for sustained transmission. The 2 children had been vaccinated in the previous year and had no known contact.

Although reassortment between swine influenza and 2009 influenza A (H1N1) viruses has been reported in pigs in the United States [Duchatez MF, Hause B, Stigger-Rosser E, et al. Multiple reassortment between pandemic (H1N1) 2009 and endemic influenza viruses in pigs, United States. Emerg Infect Dis. 2011;17:1624-9], this particular genetic combination of swine influenza virus segments is unique and has not been reported previously in either swine or humans. There was no evidence of onward transmission of this particular reassortant in humans

Therefore clinicians should consider swine-origin influenza A virus infection as well as seasonal influenza virus infections in the differential diagnosis of patients with febrile respiratory illness who have been near pigs. - Mod.CP]

For some strange reason, most birds don't like to be near me but I'll be careful and stay away from birds with runny noses.

Actually, you need to be careful of the coughing birds.

__________________There are always dozens of reasons why something "can't" be done. That's no excuse in my book. If you want it bad enough, you find a way. That's how life works for grown ups. -- Booger

so it's segment 7 (MP) which originally came from European Swine(1978)
and already reassorted a lot in swine

2009mexflu had got segments 6,7 from that 1978EurasiaSwineH1N1

we had an outbreak of H1N2 in humans in 2001-2003 which (almost)
disappeared when Fujianflu took over in 2002-2004

that H1N2 had 7 segments from seasonal H3N2(1968flu) but picked up segment 4
from seasonal H1N1(1977flu)

some years ago a new H3N1 appeared in Missouri swine, but only one infection
is known.
Then we also had H2N3,H1N3, but that didn't spread either.
However now we have losts of reassortants in swine in different segments
mixing old swinish H3N2,H1N2,H1N1 with pandemic H1N1 (mexflu,2009flu).

We have some immunity to that new H3N2 from our seasonal H3N2.
But that strain is ~20years old and thus pretty different from current human
H3N2 (40 years away, for those who had H3N2 in ~1990 only 20years away)

more dangeroud to me looks Eurasian swinish H1N1, which might
give it's H1 to other flu and we have no immunity to that one.
There were some occasional human infections in Europe with that
swinish H1N1 and they were usually mild.
But when it starts to reassort (as it does now in swine) the
cards are new mixed

On Friday, the Centers for Disease Control and Prevention reported two infections of the novel influenza A virus. One involved an Indiana boy and the other was a girl from Pennsylvania who had been to the Washington County Fair the week of Aug. 13-20, the same fair attended by those in the two newest cases..."

Okay, so we're seeing four cases of transmission - 3 which would appear to be swine to human & one in which a caretaker, not the patient had exposure. In that case, the patient had multiple health issues so I'm going to ASSUME his immune system was weaker.

My questions: why, (the three who don't have reported pre-existing health issues), were these children taken to medical care? Were parents a little too anxious? Or were the kids presenting with truly worrisome severity? The articles say nothing about this & there's no warning from any health department about particularly scary issues.

The focus seems to be on the novelty of the strain. The gene from the pandemic strain... what characteristics of the pandemic strain has it added to the new hybrid? Greater transmissibility? Sicker patients? Longer recovery period? Important things to know.

__________________"Most of what you did with Ebola was go to Africa and count corpses after the fact." - CJ Peters

A continuing investigation, which is being jointly undertaken by the departments of Health and Agriculture, as well as the Centers for Disease Control and Prevention (CDC), has not yet uncovered how the illness was transmitted to the three individuals. However, no additional human infections with this virus have been identified to date.

Anyone who attended the Washington County Fair and has flu-like symptoms should contact their local health care provider or call 1-877-PA-HEALTH. Symptoms would be similar to that of seasonal influenza, and would include fever, lethargy (extreme tiredness), lack of appetite and coughing. Other influenza symptoms may include a runny nose, sore throat, eye irritation, nausea, vomiting and diarrhea.

As the incubation time "statute of limitiations" has more or less expired, we should see no "new" cases if there is no human - human transmission. We may see confirmation of older cases if samples can be collected, but if we see new infections at 2 weeks out, I'll raise an eyebrow a bit.

The Pennsylvania departments of Health and Agriculture today announced three cases of a novel influenza A virus have been identified, and are now linked to an agricultural fair in southwestern Pennsylvania.
The cases in Pennsylvania are similar to previous, rare human infections with swine-origin H3N2 viruses, but are unique in that they contain a genetic component of the H1N1 virus.

The above comments from a Pennsylvania Department of Health press release describe two additional confirmed trH3N2 cases at the Washington County Fair. Like the earlier case in Indiana, A/Indiana/08/2011, and the previously reported case from Schuykill County, PA, who attended the above fair, the two new cases had the H1N1 M gene segment, which is linked to aerosol spread in a guinea pig model of human influenza transmission.

These cases increase the Pennsylvania total of confirmed cases to five, including three 2011 cases with the M gene segment. The three confirmed cases represent the largest number of confirmed trH3N2 cases at a given location, and the investigation is still ongoing.

The press release does not clarify the severity of the infection in the two most recent cases, who may have been ill for nore than two weeks (the fair ended August 20). Hospitalization was not addressed in the press release, but the four cases with H1N1 M1 appear to be serious enough to warrant emergency department visits.

It is likely that these three cases represent unsubtypable trH3N2 which is not recognized by the human H3 serotyping reagents, suggesting existing immunity to seasonal H3N2 will provide limited protection.
Additional cases are under investigation, but this cluster strongly supports human to human transmission of a novel trH3N2 with a pandemic H1N1 M gene segment.

The unsubtypable cases will be more easily identified by state labs, and an explosion of confirmed cases is expected.

Release of the sequences from the first PA case is overdue.

__________________"Now, mark my words. So long as we are a young and virtuous people, this instrument will bind us together in mutual interests, mutual welfare, and mutual happiness. But when we become old and corrupt, it will bind us no longer" - Alexander Hamilton about the US Constitution.

He's jumping the gun - again. I see no suggestion of 'strong support' H-H transmission. Were that the case, we'd be several transmission generations down the road at this stage with more confirmed cases. Granted, lab testing/reporting time is always slower than anyone would like & if anyone contracted this novel strain without feelng a need to seek medical attention, a lot of potential cases are being missed.

That being said, I often wonder how many novel strains enjoy a quick run with mild illness, then peter out. Impossible to tell.

__________________"Most of what you did with Ebola was go to Africa and count corpses after the fact." - CJ Peters

It's been pretty difficult to find much further info on this. The original cases were just released in this past weeks' MMWR and, of course, nothing official gets done over a holiday weekend.

Since it's fair season, it isn't surprising to see this uptick in swine-to-human transmission. According to the CDC, over the past few years, they've seen an average of 3-5 verified cases per year. But without knowing how many have already been reported, it's hard to know if these new cases will make this years total count higher.

What originally struck me about this was how fast this process has happened. The H3N2/H1N1 (2009 variant) reassortment occurred, has spread at least regionally in the swine population AND had been transmitted back to humans. All in less than 2 years. I'm certainly no expert on this stuff, but it just seems pretty fast to me.

In doing some further reading on this, one other thing jumped out at me. "The gene from the pandemic is one of the things that makes the new strain worrisome, because it appears it is important for transmission from person to person, said Dr. John Treanor, a flu specialist at the University of Rochester School of Medicine...". (From an article in the Pittsburgh Tribune Review.)

I agree that Ninman is premature in his assertion of H-H transmission. But, given the above quote, it may be that this strain has a greater than usual potential for H-H transmission.

That remains to be seen. But I posted the article because I think this bears watching.

Catbird, I'm glad you posted it. With flu virions being so mutable, I sometimes wonder that we're able to catch the emergence of new strains at all - save when they produce as truly nasty strain. I'll bet in any given flu season, dozens of 'emergent' strains ty their hardest to become established but fail. Either they're shouldered aside by more robust new strains, fail to make an impact in the presence of currently circulating ones or just don't have what it takes to succeed. It's possible some do but luckily for us, the train of transmission ends before it can continue. How any times have we avoided a pandemic because ONE case of something truly horrendous may have infected someone who lived alone & either died alone, (with no detailed testing beng done), or somehow recovered when the possible next 10 cases might have seen a very different outcome? We'll never know. Not sure I want to - I only have so any hairs that can turn grey.

It's clearly not that easy for a truly pandemic strain to emerge under any circumstances & I'll put forth that the exactly right circumstances, (which probably vary by strain), have to exist before we see serious pandemics. History bears this out. Flu has been around a long time, is a common aspect of shared human experience yet hs produced relatively few deadly pandemics.

What we are seeing - or think we're seeing - may e a matter of sheer luck. We may be viewing the birth & early development of the next predominant strain of H3N2 which is moreof a 'nuisance flu' for most or... we may e in on the earliest days of a real: "Oh shit!" strain.

We can only wait & watch.

__________________"Most of what you did with Ebola was go to Africa and count corpses after the fact." - CJ Peters

Catbird, I'm glad you posted it. With flu virions being so mutable, I sometimes wonder that we're able to catch the emergence of new strains at all - save when they produce as truly nasty strain. I'll bet in any given flu season, dozens of 'emergent' strains ty their hardest to become established but fail. Either they're shouldered aside by more robust new strains, fail to make an impact in the presence of currently circulating ones or just don't have what it takes to succeed. It's possible some do but luckily for us, the train of transmission ends before it can continue. How any times have we avoided a pandemic because ONE case of something truly horrendous may have infected someone who lived alone & either died alone, (with no detailed testing beng done), or somehow recovered when the possible next 10 cases might have seen a very different outcome? We'll never know. Not sure I want to - I only have so any hairs that can turn grey.

It's clearly not that easy for a truly pandemic strain to emerge under any circumstances & I'll put forth that the exactly right circumstances, (which probably vary by strain), have to exist before we see serious pandemics. History bears this out. Flu has been around a long time, is a common aspect of shared human experience yet hs produced relatively few deadly pandemics.

What we are seeing - or think we're seeing - may e a matter of sheer luck. We may be viewing the birth & early development of the next predominant strain of H3N2 which is moreof a 'nuisance flu' for most or... we may e in on the earliest days of a real: "Oh shit!" strain.

We can only wait & watch.

I agree with you - especially about the grey hairs!

I do wonder if 5 years from now, we'll be posting about a threat from H3N2, or a "new" novel H1N1, only to find out it's what we saw being born in this thread.

Since my crystal ball seems to be out of order, I'll join you in the waiting and watching. I will say, between one thing and another, that watch list is getting pretty damn long.

I will say, between one thing and another, that watch list is getting pretty damn long.

No kidding. Sometimes I wonder if, in some ways, we know just enough to be dangerously inclined to scare ourselves to death? We can see bacteria now & with electon microscopy, see viruses as well. We can study the genetics past & present. We know enough to recognize the RISKS implied by certain sorts of microbial evolution. We know enough to know that there's a whole lot we don't know know including no doubt, crucial keys to a pandemic launching itself. And that is indeed scary as hell.

But balancing all that off - as a species we've been around a long time & have survived a number of pandemics of different origin. And we remain.

I just don't think, in spite of all our concern, that relatively high pandemics are that easy to get going.

__________________"Most of what you did with Ebola was go to Africa and count corpses after the fact." - CJ Peters

Again, getting past the alarmist language, there are some interesting nuggets in this Ninman commentary. One of the three PA kids was sampled before the fair began, and is still recovering 6 weeks later. There has been no report of any hogs being found infected, so I'm starting to think that the fair-hog connection is spurious.

Two other individuals, confirmed ill over the weekend, are recovering.

The above comment from the September 5, 2011 Pennsylvania Department of Health press release regarding cases from Washington County raise concerns that one of the patients (9F), A/Pennsylvania/10/2011, has been “recovering” for more than six weeks.
Today the CDC released sequences from the three patients described in the above press release and one set of sequences came from a sample collected July 27, 2011. This collection date suggests this patient was infected well in advance of the August 13 start date of the Washington County Fair, raising concerns that trH3N2 infections are widespread and in the above case, severe.

__________________"Now, mark my words. So long as we are a young and virtuous people, this instrument will bind us together in mutual interests, mutual welfare, and mutual happiness. But when we become old and corrupt, it will bind us no longer" - Alexander Hamilton about the US Constitution.

On Friday, the Centers for Disease Control and Prevention reported two infections of the novel influenza A virus. One involved an Indiana boy and the other was a girl from Pennsylvania who had been to the Washington County Fair the week of Aug. 13-20, the same fair attended by those in the two newest cases..."

Historically, "County Fairs" have been sources of sporadic outbreaks of novel cross-breeds of flu. Small case counts, but unnerving to the flu followers.

He's jumping the gun - again. I see no suggestion of 'strong support' H-H transmission. Were that the case, we'd be several transmission generations down the road at this stage with more confirmed cases. Granted, lab testing/reporting time is always slower than anyone would like & if anyone contracted this novel strain without feelng a need to seek medical attention, a lot of potential cases are being missed.

That being said, I often wonder how many novel strains enjoy a quick run with mild illness, then peter out. Impossible to tell.

You have hit the proverbial nail right on the haid!!!

There are probably myriads of "dead end recombinomics" we NEVER see hide-nor-hair of because they burn out in very short order.

Flu is a roulette wheel with millions of transcription combinations with very few real winners. Or maybe more like a state lottery.

Catbird, I'm glad you posted it. With flu virions being so mutable, I sometimes wonder that we're able to catch the emergence of new strains at all - save when they produce as truly nasty strain. I'll bet in any given flu season, dozens of 'emergent' strains ty their hardest to become established but fail. Either they're shouldered aside by more robust new strains, fail to make an impact in the presence of currently circulating ones or just don't have what it takes to succeed. It's possible some do but luckily for us, the train of transmission ends before it can continue. How any times have we avoided a pandemic because ONE case of something truly horrendous may have infected someone who lived alone & either died alone, (with no detailed testing beng done), or somehow recovered when the possible next 10 cases might have seen a very different outcome? We'll never know. Not sure I want to - I only have so any hairs that can turn grey.

It's clearly not that easy for a truly pandemic strain to emerge under any circumstances & I'll put forth that the exactly right circumstances, (which probably vary by strain), have to exist before we see serious pandemics. History bears this out. Flu has been around a long time, is a common aspect of shared human experience yet hs produced relatively few deadly pandemics.

What we are seeing - or think we're seeing - may e a matter of sheer luck. We may be viewing the birth & early development of the next predominant strain of H3N2 which is moreof a 'nuisance flu' for most or... we may e in on the earliest days of a real: "Oh shit!" strain.

We can only wait & watch.

LOL! Ditto. (LEts see if the appending aggregator catches this post..,)

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Again, getting past the alarmist language, there are some interesting nuggets in this Ninman commentary. One of the three PA kids was sampled before the fair began, and is still recovering 6 weeks later. There has been no report of any hogs being found infected, so I'm starting to think that the fair-hog connection is spurious.

...sample collected July 27, 2011. This collection date suggests this patient was infected well in advance of the August 13 start date of the Washington County Fair...

One case of human infection with a novel influenza A virus was reported by the Pennsylvania Department of Health. The patient was infected with a swine origin influenza A (H3N2) virus. The patient reported contact with pigs in the week preceding symptom onset on September 6, 2010, did not require hospitalization, and has since fully recovered. Initial testing of the specimen indicated a seasonal influenza A (H3N2) virus and the specimen was submitted to CDC as a routine surveillance sample. The delay from onset to detection occurred because attempts to culture the virus were unsuccessful. RT-PCR testing confirmed swine-origin influenza A (H3N2).

The above comments from the week 4 FluView describe an earlier isolate from Pennsylvania, A/Pennsylvania/40/2010 (PA/40/10), which is closely related to A/Wisconsin/12/2010 and A/Minnesota/11/2010, which are precursors to the four confirmed trH3N2 2011 cases. As noted above, the PA/40/10 sample was initially classified as seasonal H3N2 and the announcement of trH3N2 was made 5 months after collection.

The H3 sequences from the latest trH3N2 isolates has evolved further from the 2010 sequences, and the unsubtypables listed for week 33 and week34 the week 35 report are likely A/Pennsylvania/09/2011 (PA/09/11) and A/Pennsylvania/11/2011 (PA/11/11) and suggests that the more 2011 trH3N2 isolates will register as influenza A positive, but H3 and H1 negative, which would facilitate detection by state labs who routinely determine sub-types.

However, as seen in the week 35 report, many samples are not sub-typed, and the other two recent isolates may be in that category, but made be subsequently added after sub-type failure (and associated confirmation of trH3N2).

Thus, the comments posted above, coupled with the concentration of confirmed trH3n2 cases in Pennsylvania and prior reports of unsubtypable samples warrant a review / retesting of those samples via swine specific PCR analysis, as was done with PA/09/11.

This review should identify many additional prior trH3N2 cases in the 2010/2011 season and focus testing on influenza A positive cases, including those without linkage to swine.